Comparison of sudden cardiac death in patients admitted for acute heart failure between Japan and USA

2021 Fiscal Year Final Research Report

• Project/Area Number: 17K09526
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Kyorin University (2019-2021); Keio University (2017-2018)
• Principal Investigator: Kohno Takashi 杏林大学, 医学部, 教授 (60327509)
• Project Period (FY): 2017-04-01 – 2022-03-31
• Keywords: 心不全

Outline of Final Research Achievements

This study sought to demonstrate the incidence of SCD in Japanese HF patients after hospitalization for acute decompensation, and externally validate the Seattle Proportional Risk Model (SPRM). We consecutively registered 2,240 acute HF patients. During the 2-year follow-up, 356 deaths (15.9%) occurred, which included 76 adjudicated SCDs (3.4%) and 280 non-SCDs. The SPRM showed acceptable discrimination (c-index=0.63; 95%CI, 0.56-0.70), similar to that of original SPRM-derivation cohort. Among HF patients with reduced ejection fraction (EF;<40%), SPRM showed improved discrimination compared to the ICD eligibility criteria (e.g. New York Heart Association functional class II-III with EF<35%): c-index=0.53 (95%CI, 0.42-0.63) vs. 0.65 (95%CI, 0.55-0.75) for SPRM.

Free Research Field

循環器内科学

Academic Significance and Societal Importance of the Research Achievements

心不全患者の突然死予防のための植込み型除細動器(ICD)は、ガイドラインが示す適応基準に準じた使用が推奨されているが、左室駆出率 [LVEF] 35% 未満ならびにNYHA II-IIIという一次予防基準に関しては限界があることも指摘されている。SPRMのようなリスクモデルによる個別の突然死発症リスク・ICD植込みメリットの提示は、ICD使用におけるshared decision making・個別化医療の実践に繋がると期待され、今後の活用が必要と考えられる。